COLLABORATIVE

The aim of treatment is to maintain a patent airway and provide adequate gas exchange. Medical management includes bronchodilating medications, corticosteroids, nebulized adrenaline, cool mist in a croup tent during sleep, and intravenous hydration if oral intake is inadequate. Oxygen may be used, but it masks cyanosis, which signals impending airway obstruction. Sedation is contraindicated because it may depress respirations or mask restlessness, which indicate a worsening condition. Sponge baths may be needed to control temperatures above 102°F. You may need to isolate the child if the physician suspects syncytial virus or parainfluenza infections.

Laryngoscopy may be necessary if complete airway obstruction is imminent. A flexible nasopharyngoscopy can be used; an intubation or a tracheostomy is performed only if no other method of airway maintenance is available. Keep intubation and tracheostomy trays near the bedside at all times for use in case of emergencies.

Pharmacologic Highlights

Medication or Drug Class	Dosage	Description	Rationale
Racemic epinephrine	Per nebulizer, varies depending on size of child	Sympathomimetic	Dilates the bronchioles, opening up respiratory passages
Corticosteroids	Varies with drug	Anti-inflammatory	Decrease airway inflammation if epinephrine is not effective
Antipyretics	Varies with drug	Salicylates, acetaminophen, NSAIDs	Reduce fever often present in LTB
Antibiotics	Varies with drug	Type of antibiotic depends on the causative organism	Fight bacterial infections

INDEPENDENT

Ongoing, continuous observation of the patency of the child's airway is essential to identify impending obstruction. Prop infants up on pillows or place them in an infant seat; older children should have the head of the bed elevated so that they are in Fowler's position. Sore throat pain can be decreased by soothing preparations such as iced pops or fruit sherbet. If the child has difficulty swallowing, avoid thick milkshakes.

Children should be allowed to rest as much as possible to conserve their energy; organize your interventions to limit disturbances. Provide age-appropriate activities. Crying increases the child's difficulty in breathing and should be limited if possible by comfort measures and the presence of the parents; parents should be allowed to hold and comfort the child as much as possible. Children sense anxiety from their parents; if you support the parents in dealing with their anxiety and fear, the children are less fearful. A child's anxiety and agitation will most likely exacerbate the symptoms and need to be avoided if possible. Carefully explaining all procedures and allowing the parents to participate in the care of the child as much as possible help relieve the anxieties of both child and parents.

Provide adequate hydration to liquefy secretions and to replace fluid loss from increased sensible loss (increased respirations and fever). The child also might have a decreased fluid intake during the illness. Clear liquids should be offered frequently. Apply lubricant or ointment around the child's mouth and lips to decrease the irritation from secretions and mouth breathing.